July December Research Articles

A Descriptive Study to Assess Neonatal Stress Behavior Among Preterm Neonates Admitted in NICU, Nehru Hospital, PGIMER, Chandigarh

Background Preterm neonates are repeatedly exposed to many stressors in initial days of life such as environmental stressor (light and noise) and caregiver interventions (weighing, oral and tracheal suctioning, drawing blood samples, etc.). If preterm neonates’ stress is not recognized and left untreated, there may be long-term effects. Objective To assess the neonatal stress behavior among preterm neonates admitted in neonatal intensive care unit (NICU), Nehru Hospital, PGIMER, Chandigarh. Methodology A descriptive study was conducted to assess neonatal stress behavior among preterm neonates admitted in NICU, Nehru Hospital, PGIMER, Chandigarh. Ethical clearance was taken from Institutional Ethics Committee of PGIMER, Chandigarh. Total 100 participants admitted in NICU during the period of July–December 2022 were enrolled for the study using consecutive sampling technique. Data was collected by interviewing mother using interview schedule. It comprised of sociodemographic cum clinical profile of the preterm neonate. Observation was made by using—(a) modified infant positioning assessment tool (IPAT), (b) neonatal stress scale, and (c) preterm neonate’s behavior assessment scale. Results The present study shows that 88% of the preterm neonates show moderate stress and 70% of preterm neonates exhibit suspected abnormal behavioral response in terms of autonomic visceral subsystems, while 54% of the preterm neonates show suspected abnormal behavioral response in terms of state regulation attention interaction subsystem. Conclusion The present study concluded that moderate stress level and suspected abnormal behavioral response were found among hospitalized preterm neonates.

Faculty development: Need assessment survey in a newly established Medical College of Lahore.

Objective: To assess the needs of faculty regarding teaching, assessment and research methods so as to develop a program in a newly established medical college of Lahore. Study Design: Descriptive Cross-sectional study. Setting: Rashid Latif Khan University (RLKU) Medical and Dental College, Lahore. Period: July–December 2023. Methods: Descriptive study was conducted in RLKU Medical College within six months. Structured self- administered questionnaires were used for data collection via Google forms. A total of 50 faculty members gave data after verbal consent. IRB approvals were taken. Data was analysed using Excel. Frequencies and percentages were calculated. Results: Majority faculty members (88%) preferred student cantered teaching approach with the usage (94%) of different methodologies in small group teaching. Feedback was being taken regarding teaching and assessment by majority (90%). Workshops on teaching methodologies was the area of interest especially small group teaching (62%), peer assisted learning (54%), problem based learning (54%) and large group teaching (52%). Most of them expressed need of workshops on assessment especially assessment types (60%), MCQ (56%), OSPE/OSCE (54%) construction. Faculty was of the opinion that workshops on mentoring (72%), reflection (56%), portfolio development (64%), research methodology (76%), computer skills (70%), ethics (60%) and soft skills (82%) need to be conducted. Conclusion: Workshops on teaching methodologies and assessments are essential our study concludes that although most of the faculty is trained but they still feel the need for workshops to keep them updated and trained in major aspects of curriculum delivery as well as research, mentoring, computer and soft skills highlighting the need of a robust faculty development program.

(062) IMPLEMENTING A VALIDATED SEXUAL DYSFUNCTION SCREENING TOOL AT AN INNER-CITY WOMEN’S HEALTH CLINIC

Abstract Introduction The American College of Obstetricians and Gynecologists (ACOG) reports 43% of American women experience sexual health problems, including Female Sexual Interest and Arousal Disorder, Female Orgasmic Disorder, Genito–Pelvic Pain and Penetration Disorder, and Substance or Medication-Induced Sexual Dysfunction. Objective At Women’s Ambulatory Health Services (WAHS), an inner-city clinic associated with Hartford HealthCare, at which UConn Health ObGyn residents work, there is no routine screening in place for sexual dysfunction. This project aimed to implement the Female Sexual Function Index (FSFI) for screening for sexual dysfunction at this clinic to identify patients who may benefit from treatment. Methods We implemented the FSFI-short version, a six-question screening tool for sexual dysfunction that has been validated in English and Spanish and utilized in many countries on July 1st, 2022. Patients presenting for a new gynecologic visit or an annual gynecologic exam were asked to complete the screening tool. Patients who scored equal to or less than 18 on the FSFI-short version were identified as at risk for female sexual dysfunction and were offered referral to a health psychologist specializing in sexual dysfunction. We utilized the RE-AIM framework for implementation science to guide the implementation evaluation. We collected data on patients from July 1 through December 1, 2022. We collected patient demographics and implementation outcomes, including rate of survey completion, candidacy for referral and referral completion. Results 196 surveys were reviewed between July 1st and December 1st of 2022. 44 surveys were excluded for various reasons, including not meeting study inclusion criteria or invalid responses. 152 screening forms were included and 45 patients screened positive. Subjective patient barriers were gathered from comments written directly onto the paper survey as well as quotes documented by their providers in the visit note. These subjective barriers included hesitancy to discuss sexual health and lacking knowledge that the gynecologist provider offers assessment and management for these disorders. Conclusions The introduction of the FSFI-sv at WAHS has both expanded the resources offered to patients, enhanced the environment surrounding topics of women’s health both between staff members as well as within the patient-provider relationship, and has unearthed multiple opportunities for improving the screening process, referral selection and work flow for sexual dysfunction amongst the patient population. Disclosure No.

(069) ASSESSING READABILITY, UNDERSTANDABILITY, ACTIONABILITY, AND QUALITY OF ONLINE HEALTH RESOURCES FOR SEXUAL HEALTH DURING MENOPAUSE

Abstract Introduction Recent studies indicate that over half of adults in the United States rely on the internet for accessing health-related information. (1) Patients experiencing menopause may feel a sense of embarrassment about their sexual health and, consequently, turn to online resources to maintain a sense of anonymity. Despite a shift in information-seeking patterns within the last decade, there remains a significant gap in the research assessing the quality of the content that patients encounter online. While prior research has investigated the readability of materials for sexual health promotion and sexual health in men, there are no prior investigations addressing the quality of sexual health materials for individuals experiencing menopause. Objective Our objective was to evaluate online patient- oriented health resources concerning sexual health during menopause for their readability, understandability, actionability, and overall quality. Methods We conducted a Google keyword search for “sexual health during menopause,” reviewed the first three pages of results, and included 22 unique, relevant resources after excluding journal articles and materials not intended for patient education. We assessed readability using multiple established indices, including the Flesch-Kincaid Grade Level. Understandability and actionability were evaluated with the Patient Education Materials Assessment Tool (PEMAT), with a threshold of 70% for actionable or understandable resources. (2) The JAMA benchmark criteria were used to evaluate the quality of each site.(3) Further analysis will consist of qualitative content analysis and assessment of accuracy. Finally, these resources will be compared by the website publisher's industry for any statistically significant differences in any of these outcomes. Results No materials met the American Medical Association's recommended readability standards by any metric.(4) The reading level of the reviewed resources ranged from grades 7 to 18. PEMAT scoring revealed that three resources reached the threshold for understandability though none met the criteria for actionability. On average, understandability was 60.1% and actionability was 51.8%. No resource met all four JAMA benchmark criteria. The average criteria met was 2.0. Correlation analysis demonstrated a strong negative correlation between materials’ readability and understandability (r = −0.459, P < .05). Conclusions These findings underscore the need for improved patient resources for women’s sexual health during menopause. Future efforts in patient education materials development should prioritize patient concerns and enhancing readability, understandability, and actionability. Sources: 1. Wang X, Cohen RA. Health information technology use among adults: United States, July–December 2022. NCHS Data Brief, no 482. Hyattsville, MD: National Center for Health Statistics. 2023. DOI: https://dx.doi.org/10.15620/cdc:133700. 2. Shoemaker SJ, Wolf MS, Brach C. Development of the Patient Education Materials Assessment Tool (PEMAT): a new measure of understandability and actionability for print and audiovisual patient information. Patient Educ Couns. 2014;96(3):395–403. 3. Silberg WM, Lundberg GD, Musacchio RA. Assessing, Controlling, and Assuring the Quality of Medical Information on the Internet: Caveant Lector et Viewor-Let the Reader and Viewer Beware. JAMA. 1997;277(15):1244–1245. doi:10.1001/jama.1997.03540390074039 4. American Medical Association. CHAPTER 9: OPINIONS ON PROFESSIONAL SELF-REGULATION. https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/code-of-medical-ethics-chapter-9.pdf Published 2016 Disclosure No.

Infectious Agents of Reptiles and Amphibians: Peer-Reviewed Publications, July–December 2023

Infectious Agents of Reptiles and Amphibians: Peer-Reviewed Publications, July–December 2023

Induced Abortion and Out-of-State Travel Among Insured Women Before and After the Dobbs v. Jackson Women's Health Organization Decision

OBJECTIVE: To quantify changes in abortion rates and out-of-state travel for abortion among insured women before and after the Dobbs v. Jackson decision. METHODS: This was a cross-sectional analysis of IQVIA's anonymized, patient-level preadjudicated medical claims on induced medication or procedural abortions among 43.1 million insured women of reproductive age (15–49 years) in the United States. We used information from the Guttmacher Institute to stratify states based on post-Dobbs abortion access policy: 1) legal with protections, 2) legal with restrictions, 3) partial ban, and 4) full ban. The main outcomes were 1) total number and rate of abortions per 100,000 women of reproductive age and 2) proportion of women with out-of-state abortions before (July–December 2021) and after (July–December 2022) Dobbs. RESULTS: Between January 2021 and December 2022, a total of 212,875 women of reproductive age (mean±SD age 28.1±6.5 years) had at least one induced abortion. In a comparison of the pre-Dobbs period with the post-Dobbs periods, there were increases in both the total number of women with at least one abortion (from 54,634 to 57,017) and the rate of abortions (from 121.7 to 137.7/100,000). Increases in abortion rates were driven primarily by states where abortion is legal with protections (from 278.5 to 328.5/100,000), whereas abortion rates declined slightly in states with partial (from 16.1 to 15.0/100,000) and full (from 7.2 to 6.8/100,000) abortion bans. Increases in the percentage of women traveling out of state to obtain an abortion were observed only in restrictive states and were greatest in states with full abortion bans (27.4% before Dobbs to 53.4% after Dobbs) (P<.001). CONCLUSION: There was a modest increase in abortion rates among insured women nationally after Dobbs, with modest increases in abortions among residents of states with protective abortion policies and increases in out-of-state abortions among residents of full- and partial-ban states.

A joinpoint analysis examining trends in firearm injuries at six us trauma centers from 2016 to 2022

BackgroundThere is an epidemic of firearm injuries in the United States since the mid-2000s. Thus, we sought to examine whether hospitalization from firearm injuries have increased over time, and to examine temporal changes in patient demographics, firearm injury intent, and injury severity.MethodsThis was a multicenter, retrospective, observational cohort study of patients hospitalized with a traumatic injury to six US level I trauma centers between 1/1/2016 and 6/30/2022. ICD-10-CM cause codes were used to identify and describe firearm injuries. Temporal trends were compared for demographics (age, sex, race, insured status), intent (assault, unintentional, self-harm, legal intervention, and undetermined), and severity (death, ICU admission, severe injury (injury severity score ≥ 16), receipt of blood transfusion, mechanical ventilation, and hospital and ICU LOS (days). Temporal trends were examined over 13 six-month intervals (H1, January–June; H2, July–December) using joinpoint regression and reported as semi-annual percent change (SPC); significance was p < 0.05.ResultsFirearm injuries accounted for 2.6% (1908 of 72,474) of trauma hospitalizations. The rate of firearm injuries initially declined from 2016-H1 to 2018-H2 (SPC = − 4.0%, p = 0.002), followed by increased rates from 2018-H2 to 2020-H1 (SPC = 9.0%, p = 0.005), before stabilizing from 2020-H1 to 2022-H1 (0.5%, p = 0.73). NH black patients had the greatest hospitalization rate from firearm injuries (14.0%) and were the only group to demonstrate a temporal increase (SPC = 6.3%, p < 0.001). The proportion of uninsured patients increased (SPC = 2.3%, p = 0.02) but there were no temporal changes by age or sex. ICU admission rates declined (SPC = − 2.2%, p < 0.001), but ICU LOS increased (SPC = 2.8%, p = 0.04). There were no significant changes over time in rates of death (SPC = 0.3%), severe injury (SPC = 1.6%), blood transfusion (SPC = 0.6%), and mechanical ventilation (SPC = 0.6%). When examined by intent, self-harm injuries declined over time (SPC = − 4.1%, p < 0.001), assaults declined through 2019-H2 (SPC = − 5.6%, p = 0.01) before increasing through 2022-H1 (SPC = 6.5%, p = 0.01), while undetermined injuries increased through 2019-H1 (SPC = 24.1%, p = 0.01) then stabilized (SPC = − 4.5%, p = 0.39); there were no temporal changes in unintentional injuries or legal intervention.ConclusionsHospitalizations from firearm injuries are increasing following a period of declines, driven by increases among NH Black patients. Trauma systems need to consider these changing trends to best address the needs of the injured population.

A Single-Buyer Model of Imbalance Cost Pass-Through Pricing Forecasting in the Malaysian Electricity Supply Industry

The imbalance cost pass-through (ICPT) is a flexible component of the incentive-based regulation (IBR) that empowers power producers to adjust tariffs in response to variable fuel prices, thereby enhancing the economic resilience of electricity generation. In Malaysia, the Energy Commission has conducted biannual reviews of fuel and other generation costs. Any cost savings or increases identified during these reviews will be passed on to customers in the form of rebates or surcharges. Meanwhile, if an increment in the ICPT price signal can be provided to electricity providers and consumers, early preparation for operation budgeting can be realised, and energy management program development can be properly prepared. Due to this reason, this study proposes ICPT price forecasting for the electricity market in Peninsular Malaysia that will benefit the stakeholders. The study aims to construct an ICPT-related baseline model for the peninsular generation data by employing three forecasting methods. The forecasting performance is analysed using the mean absolute percentage error (MAPE). In light of our findings, the ARIMA method is one of the most accurate forecasting methods for fuel prices compared to the moving average (MA) and LSSVM methods. The observed price differences between the ARIMA and LSSVM models for ICPT are minimal. The ICPT price for July–December 2022 and January–June 2023 is MYR 0.21/kWh for the ARIMA and MYR 0.18/kWh for LSSVM, which are close to the actual TNB’s ICPT tariff. As for forecasting, the ICPT price is expected to drop in the next announcement. The findings of this study may have a positive impact on the sustainability of the energy sector in Malaysia.

Genomic characterization of Influenza A (H1N1)pdm09 and SARS-CoV-2 from Influenza Like Illness (ILI) and Severe Acute Respiratory Illness (SARI) cases reported between July–December, 2022

Influenza Like Illness (ILI) and Severe Acute Respiratory Infection (SARI) cases are more prone to Influenza and SARS-CoV-2 infection. Accordingly, we genetically characterized Influenza and SARS-CoV-2 in 633 ILI and SARI cases by rRT-PCR and WGS. ILI and SARI cases showed H1N1pdm09 prevalence of 20.9% and 23.2% respectively. 135 (21.3%) H1N1pdm09 and 23 (3.6%) H3N2 and 5 coinfection (0.78%) of H1N1pdm09 and SARS-CoV-2 were detected. Phylogenetic analysis revealed H1N1pdm09 resemblance to clade 6B.1A.5a.2 and their genetic relatedness to InfA/Perth/34/2020, InfA/Victoria/88/2020 and InfA/Victoria/2570/2019. Pan 24 HA and 26 NA nonsynonymous mutations and novel HA (G6D, Y7F, Y78H, P212L, G339R, T508K and S523T) and NA (S229A) mutations were observed. S74R, N129D, N156K, S162N, K163Q and S164T alter HA Cb and Sa antibody recognizing site. Similarly, M19T, V13T substitution and multiple mutations in transmembrane and NA head domain drive antigenic drift. SARS-CoV-2 strains genetically characterized to Omicron BA.2.75 lineage containing thirty nonsynonymous spike mutations exhibited enhanced virulence and transmission rates. Coinfection although detected very minimal, the mutational changes in H1N1pdm09 and SARS-CoV-2 virus infected individuals could alter antibody receptor binding sites, allowing the viruses to escape immune response resulting in better adaptability and transmission. Thus continuous genomic surveillance is required to tackle any future outbreak.

Postnatal care provided by UK midwifery units and the impact of the COVID-19 pandemic: A survey using the UK Midwifery Study System (UKMidSS)

BackgroundPostnatal care supports healthy transitions to parenthood, mother-infant relationships, and breastfeeding establishment. Highly valued by women and families, it is often an area where parents report low satisfaction compared with other areas of maternity care. Most research about postnatal care is hospital-focused. Little is known about postnatal services provided by midwifery units, and any changes to this provision since the COVID-19 pandemic. AimTo describe postnatal care services provided by UK midwifery units and examine the extent to which provision was affected by the COVID-19 pandemic. MethodsWe carried out a national survey online between January–June 2022 using the United Kingdom Midwifery Study System (UKMidSS). We asked about postnatal care provision in alongside midwifery units (AMU) and freestanding midwifery units (FMU), before the COVID-19 pandemic (July–December 2019) and shortly after restrictions were eased (January–June 2022). FindingsOverall 131 (67 %) midwifery units responded to the survey, 76 (62 %) AMUs and 55 (75 %) FMUs, from 75 % of eligible NHS organisations. In 2022, 66 % of AMUs reported that women typically stayed for 6–24 h after a straightforward birth, while 70 % of FMUs reported typical postnatal stays of <6 h. For 2019, significantly more FMUs reported providing outpatient postnatal services compared with AMUs (98 % vs 57 %, p < 0.001). From 2019 to 2022 there were significant reductions in partners staying overnight in midwifery units (65 %–42 %, p < 0.001), and in the provision of outpatient postnatal breastfeeding groups (23 %–15 %, p < 0.01) and other postnatal groups (7 %–2 %, p = 0.02). ConclusionsThe findings document the ways in which postnatal care provision differs between AMUs and FMU, with potential consequences for choice and experience for women. They are also congruent with evidence that maternity care was adversely affected by the COVID-19 pandemic, including a reduction in postnatal visiting for partners and in postnatal group support services.

EU Contract Case Law, July–December 2023

Abstract This article provides an overview of the most relevant cases decided by the Court of Justice of the European Union concerning contract law. The present issue covers the period between the beginning of July 2023 and the end of December 2023. Out of a total of 220 judgments decided in this period, 57 had a contract law dimension.

Development of a QR Code-based Woodworking Practice Jobsheet

This research was motivated by the need for the development of jobsheets to support the learning process in the Wood Working Practices course at the Department of Civil Engineering, Faculty of Engineering, Padang State University. The purpose of this research is to produce a QR code-based jobsheet that is valid and practical to use as a learning support medium in the Wood Working Practices course. The research method used is Research and Development (R&amp;D) with the DDD-E development model, which consists of Decide, Design, Develop, and Evaluate stages. The instrument used in this research is a questionnaire to test the validity and practicality of the product. The research subjects consisted of three lecturers or experts of the Wood Working Practices course who acted as assessors in the product validity level test, and 16 students of the Building Engineering Education study program who took the Wood Working Practices course in the July–December 2023 semester who played a role in the product practicality level test stage. The results of the validation test of the QR Code-assisted Wood Working Practice job sheet showed a high level of validity, with a rating of 94% for Media Expert 1, 92% for Media Expert 2, and 99% for Media Expert 3. As for the student usability test of the QR Code-assisted Wood Work Practice jobsheet, a score of 93% was achieved in the highly usable category. Based on the results of this study, it can be concluded that the QR Code-assisted Wood Work Practice jobsheet can be said to be valid and practical for use in the learning process of the Wood Work Practice course at the Department of Civil Engineering, Faculty of Engineering, Padang State University.

Students Perceptions of The Implementation of Occupational Safety and Health Work on Wood Working Practices

The lack of knowledge and how to use tools when practicing can cause work accidents that harm students and schools that make this research raised. Occupational safety and health are mandatory things at work, which is the main step before starting the activity, so that students can understand the meaning of occupational safety and health itself. The purpose of this study was to reveal students' perceptions of the application of occupational safety and health in Woodworking Practices in the Class XI DPIB Workshop of SMK Negeri 1 West Sumatra. A descriptive research model was used in a quantitative approach. The product was validated by two experts and 30 students who took Woodworking Practice subjects in the July–December 2023 semester. Based on the validation that has been carried out by material expert 1, the result is 80% with good criteria; material expert 2 obtained a result of 81% with good criteria. Based on the results of this study, it can be concluded that students' perceptions of the application of occupational safety and health in woodworking practices in workshops that use descriptive research with quantitative.

Efficacy and effects of three desiccation intervals on biofouling and Eastern oysters (Crassostrea virginica) at three commercial oyster farms in the Chesapeake Bay, MD

Oyster aquaculture is a growing industry both globally and nationally. Productive coastal waters support high-density containerized culture of oysters, but also sustain many other macrofaunal species which can settle on oysters and cage materials (biofouling), causing problems for oyster farms. Desiccation, or periodic air drying, of farm infrastructure and oysters has been used to control colonization and growth of biofouling organisms on oyster farms worldwide, but the minimum necessary interval of desiccation has yet to be thoroughly assessed. Given the known stresses to oysters associated with periods of emersion, an understanding of the effects of different weekly desiccation intervals is needed. This study investigated the use of desiccation in controlling biofouling and the associated impacts to oyster growth and mortality at three oyster farms within Maryland's portion of the Chesapeake Bay, including one low salinity site in an upper Chesapeake Bay tributary and two sites in the middle portion of the Chesapeake Bay. Three desiccation treatments were applied at each site: control (no desiccation), 8 consecutive hours of desiccation per week, and 24 consecutive hours of desiccation per week. Oysters were deployed between July–December 2018 and the percent valve coverage by individual biofouling species was monitored, along with worm abundance, oyster growth, and oyster mortality. Total biofouling was significantly greater on non-desiccated oysters but minimal differences in biofouling coverage were observed among oysters desiccated for 8 or 24 h weekly. Seven biofouling species were observed among the sites, and all except for a single macroalgal species (Ulva intestinalis) were controlled by the 8- and 24-h desiccation treatments. No clear treatment-derived differences in oyster growth or mortality were observed. Overall, results suggest desiccating weekly for either 8 or 24 consecutive hours may be a suitable biofouling management strategy for gross biofouling reduction on oyster farms.

Knowledge, risk perception and uptake of COVID-19 vaccination among internally displaced persons in complex humanitarian emergency setting, Northeast Nigeria

BackgroundOwing to crowded and unsanitary conditions, internally displaced persons (IDPs) have an increased risk of COVID-19 infection. Adoption of COVID-19 preventive measures among this population is premised on accurate information, adequate knowledge, and risk perception. We assessed COVID-19 knowledge and risk perception and investigated the association between risk perception and COVID-19 preventive measures, including vaccination among IDPs in Northeast Nigeria.MethodsWe conducted a cross-sectional study during July–December 2022 and sampled 2,175 IDPs using stratified sampling. We utilized a 12-point assessment tool to evaluate COVID-19 knowledge. Participants who scored ≥ 6 points were considered to have adequate knowledge. We used a 30-item Risk Behavior Diagnosis Scale to assess COVID-19 risk perception and evaluated each item on a 5-point Likert scale. Participants were divided into risk perception categories by the median of Likert scale scores. We performed weighted logistic regression analysis to identify factors associated with risk perception. Pearson’s chi-squared with Rao-Scott adjustment was used to determine the relationship between risk perception and COVID-19 preventive measures.ResultsOf 2,175 participants, 55.7% were 18–39 years old, 70.9% were females, and 81.7% had no formal education. Among the IDPs, 32.0% (95% CI: 28.8 – 35.0) were considered to have adequate COVID-19 knowledge, and 51.3% (95% CI: 47.8 – 54.8) perceived COVID-19 risk as high. Moreover, 46.3% (95% CI: 42.8 – 50.0) had received one dose of COVID-19 vaccine, and 33.1% (95% CI: 29.8 – 36.0) received two doses. Adequate knowledge (Adjusted Odds Ratio (AOR) = 2.10, [95% CI: 1.46 – 3.03]) and post-primary education (AOR = 3.20, [95% CI: 1.59 – 6.46]) were associated with risk perception. Furthermore, high risk perception was significantly associated with wearing face masks (χ2 = 106.32, p-value < .001), practicing hand hygiene (χ2 = 162.24, p-value < .001), physical distancing (χ2 = 60.84, p-value < .001) and vaccination uptake (χ2 = 46.85, p-value < .001).ConclusionsThis study revealed gaps in COVID-19 knowledge, risk perception, and vaccination uptake but demonstrated a significant relationship between risk perception and COVID-19 preventive practices. Health education and risk communication should be intensified to improve knowledge, elicit stronger risk perception, and enhance COVID-19 preventive practices.

State-level differentials in COVID-19 fatality: exploring age and sex disparities in Malaysia’s pandemic experience

IssueCOVID-19 has resulted in mortality worldwide and exposed vulnerabilities in public health systems. Although countries have since transitioned to the endemic phase, it is nonetheless important to identify inequities within populations to improve public health strategies in light of another health crisis.PurposeThis study aims to offer deeper insights into the sex and age differentials in COVID-19 fatality across different states in Malaysia, from the pandemic’s start to the country’s transition to the endemic phase.MethodologyAnalyses utilized data on the number of COVID-19 cases and deaths in Malaysia from January 2020 until April 2022. Case fatality rate (CFR) was computed for each state based on sex and age groups, for four periods (January–December 2020, January–June 2021, July–December 2021, and January–April 2022). Principal component analysis (PCA) uncovered patterns in the data and produced a multivariate visualization of the COVID-19 fatality within Malaysia.FindingsFindings revealed heterogeneity in fatality and identified several vulnerable states, notably in the northern region (Kelantan, Perlis) and on the East Coast (Sabah, Sarawak). A sex disparity was apparent in Kelantan as the CFR among older females was higher than their male counterparts. Sabah exhibited relatively higher CFR among the child population from 2020 to 2021.ImplicationThe findings deepened our understanding of COVID-19 fatality complexity, providing recommendations for Malaysia’s government in preparing for future health crises. Malaysia’s case study offers lessons on the need to address regional disparities and implement targeted strategies to protect vulnerable subgroups.

Metabolomic signature between diabetic and non-diabetic obese patients: A protocol for systematic review.

Type 2 diabetes mellitus (T2DM) is a chronic and progressive condition defined by hyperglycemia caused by abnormalities in insulin production, insulin receptor sensitivity, or both. Several studies have revealed that higher body mass index (BMI) is associated with increasing risk of developing diabetes. In this study, we perform a protocol for systematic review to explore metabolite biomarkers that could be used to identify T2DM in obese subjects. The protocol of this review was registered in PROSPERO (CRD42023405518). Three databases, EMBASE, PubMed, and Web of Science were selected to collect potential literature from their inceptions to July December 2023. Data for collection will include title, authors, study subjects, publication date, sample size, detection and analytical platforms, participant characteristics, biological samples, confounding factors, methods of statistical analysis, the frequency and directions of changes in potential metabolic biomarkers, and major findings. Pathway analysis of differential metabolites will be performed with MetaboAnalyst 5.0 based on the Kyoto Encyclopedia of Genes and Genomes (KEGG) and the Human Metabolome Database. The results of this systematic review will be published in a peer-reviewed journal. This systematic review will summarize the potential biomarkers and metabolic pathways to provide a new reference for the prevention and treatment of T2DM in obese subjects.

Causes and prevalence of prenatal and neonatal mortality in the District Dera Ismail Khan, Khyber Pakhtunkhwa, Pakistan

Objectives: Perinatal mortality is among the key health, prosperity, and economic status indicators. This retrospective study determines the causes of prenatal (stillbirth) and neonatal mortality during July–December 2021 and their yearly prevalence during 2013–2021 in the Women and Children’s Hospital in the district Dera Ismail Khan. Materials and Methods: The data were extracted from the admission registers maintained by the said hospital and were found not in organized and consolidated form. A month-wise organized/consolidated report for each cause of mortality was prepared. Results: A total of 508 cases of both prenatal and neonatal mortality in the nursery ward indicated hypoxic-ischemic encephalopathy (HIE) showed overall 39.8% mortality in the study area, followed by premature (15.4%), senile prostatic enlargement (10%), low birth weight revealed (9.3%), birth asphyxia (5.3%), neonatal jaundice (4.5%), respiratory distress syndrome (4.3%), non-nutritive sucking (3.5%), congenital heart defects (2.4%), meconium aspiration syndrome (1.8%), and the remaining cases each contributed to ≤0.6% of overall mortality. The isolation ward contributed (48.5%), followed by the labor room (42.4%), the nutrition ward (6.1%), and the Gynae wards (3%) of all 33 cases. The overall highest mortality occurred in 2019 (15.4%) and lowest in 2013 (6.8%). The remaining years showed each &lt;10% mortality. Neonatal mortality was mostly higher than prenatal mortality during 2013–2021 and highest (85.8%) in 2013 and the lowest (19%) in 2014. The highest and lowest prenatal mortality was 81% (2014) and 14.2% (2013), respectively. Conclusion: HIE caused about 40% of perinatal mortality. Neonatal mortality showed higher prevalence than prenatal mortality except in 2014.

Pharmacogenetic testing and monitoring of complete blood counts among Veterans newly prescribed thiopurine treatments: a retrospective cohort study

Pharmacogenetic (PGx) testing before initiation of thiopurine treatment and CBC monitoring post-initiation helps avoid adverse events and ensure patient safety. This study aims to evaluate trends in PGx testing and CBC monitoring among Veterans prescribed azathioprine, thioguanine, or mercaptopurine to demonstrate VA’s efforts to improve medication safety after an adverse event. To assess testing patterns, we used VA electronic health report data to identify 20,524 Veterans who first began thiopurine treatment between January 1, 2010, to December 31, 2021. Aggregate monthly counts of thiopurine prescriptions and associated lab tests were tabulated, and the trend in the proportion of patients tested was analyzed using the Mann–Kendall test. The proportion of patients undergoing PGx testing rose from 30.0% in 2010 to 47.5% in late 2014 (July–December). However, PGx testing and overall testing only increased slightly after the sentinel event, and orders levelled off over time at slightly lower levels than before the sentinel event. Very little change was seen in the overall proportion of individuals receiving any testing across all patients with new prescriptions from the time of the sentinel event in 2014 to the end of 2021. A large portion of patients prescribed thiopurine drugs did not receive testing that could help prevent the development of potential adverse events, leading to a predominantly reactive approach. Increased PGx testing may result in a more proactive approach to the prevention of adverse events due to genetic interaction.

Safety of Janssen Ad26.COV.S and Astra Zeneca AZD1222 COVID-19 Vaccines among Mobile Phone Users in Malawi: Findings from a National Mobile-Based Syndromic Surveillance Survey, July 2021 to December 2021

The safety profiles of the Ad26.COV2.S and AZD1222 COVID-19 vaccines have not been described in the general population in Malawi. We present self-reported adverse events (AE) following the receipt of these vaccines in Malawi as part of a national syndromic surveillance survey. We conducted phone-based syndromic surveillance surveys among adults (≥18 years) with verbal consent. We used secure tablets through random digit dialing to select mobile phone numbers and collected data electronically. Survey questions included whether the respondent had received the COVID-19 vaccines, whether they had experienced any AE following vaccination, and the severity of the AE. We used multivariable analysis to identify factors associated with self-reported AE post-COVID-19 vaccination. A total of 11,924 (36.0%) out of 33,150 respondents reported receiving at least one dose of either Ad26.COV2.S or AZD1222 between July–December 2021; of those, 65.1% were female. About 49.2% of the vaccine recipients reported at least one AE, 90.6% of which were mild, and 2.6% were severe. Higher education level and concern about the safety of COVID-19 vaccines were associated with AE self-report (Adjusted Odds Ratio [AOR] 2.63 [95% CI 1.96–3.53] and 1.44, [95% CI 1.30–1.61], respectively), while male gender and older age were associated with reduced likelihood of AE self-report (AORs 0.81, [95% CI 0.75–0.88], 0.62 [95% CI 0.50–0.77], respectively). Ad26.COV2.S and AZD1222 vaccines are well-tolerated, with primarily mild and few severe AE among adults living in Malawi. Self-reporting of AE following COVID-19 vaccination is associated with gender, age, education, and concern about the safety of the vaccines. Recognizing these associations is key when designing and implementing COVID-19 vaccination communication messages to increase vaccination coverage.